| NPI | 1942298484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX PT1193338) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1193338) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2023-11-14 |